“A STDUY TO ASSESS THE EFFECTIVENESS ON KNOWLEDGE AND PRACTICE

REGARDING HYPOGLYCEMIA AND ITS SELF CARE MANAGEMENT AMONG

DIABETES MELLITUS CLIENTS IN SELECTED HOSPITALS AT HISAR, HARYANA.”

Dinesh, P. V., Kulkarni, A. G., & Gangadhar, N. K. (2016). Knowledge and self-care practices
regarding diabetes among patients with Type 2 diabetes in Rural Sullia, Karnataka: A
community-based, cross-sectional study. Journal of family medicine and primary care, 5(4),
847–852. https://doi.org/10.4103/2249-4863.201176

Dinesh, P. V., et. al. (2016) conducted a study on Knowledge and self-care practices
regarding diabetes among patients with Type 2 diabetes in Rural Sullia, Karnataka: A
community-based, cross-sectional study. The sample size was calculated to be 400, and the
sampling method was probability proportionate to sampling size. The result shows majority
of them were married males of Hindu religion and belonged to upper middle class. Only
24.25% of them had good knowledge. Among the self-care practices, foot care was the most
neglected area. This study concluded that only one-fourth of the study population had a good
knowledge toward diabetes. Adherence to some of the self-care practices was also poor.
Government policies may help in creating guidelines on diabetes management, funding
community programs for public awareness, availability of medicines, and diagnostic services
to all sections of the community.

Shriraam, V., Mahadevan, S., Anitharani, M., Jagadeesh, N. S., Kurup, S. B., Vidya, T. A., &
Seshadri, K. G. (2015). Knowledge of hypoglycemia and its associated factors among type 2
diabetes mellitus patients in a Tertiary Care Hospital in South India. Indian journal of
endocrinology and metabolism, 19(3), 378–382. https://doi.org/10.4103/2230-8210.152779

Shriraam, V., et. al. (2015). Knowledge of hypoglycemia and its associated factors among
type 2 diabetes mellitus patients in a Tertiary Care Hospital in South India. The study
included 366 type 2 diabetic patients, of which 76.5% were females. The target fasting and
postprandial blood glucose levels while on treatment was known to 135 (36.9%) and 126
(34.4%) patients, respectively. The common symptoms of hypoglycemia known to the study
subjects were dizziness (81.4%), weakness (73.8%), and drowsiness (72.1%). Overall, 242
(66.1%) diabetic patients had good knowledge on hypoglycemia (knowledge of at least three
symptoms of hypoglycemia together with at least one precipitating factor and at least one
remedial measure). This study concluded that although the knowledge on symptoms of
hypoglycemia, precipitating factors, remedial measures are high in this study, the target blood
levels, complications were known to just a third of them. There is a knowledge gap on
important aspects of hypoglycemia among type 2 diabetic patients.

P, Thenmozhi & M, Vijayalakshmi. (2018). Knowledge On Hypoglycemia Among Patients

With Diabetes Mellitus. Asian Journal of Pharmaceutical and Clinical Research. 11. 236.
10.22159/ajpcr.2017.v11i1.22336.

P, Thenmozhi & M, Vijayalakshmi. (2018) conducted a study on Knowledge On

Hypoglycemia Among Patients With Diabetes Mellitus. A cross-sectional research design was
adopted with 60 samples who met the inclusion criteria in the rural community in India.
Structured interview method was used to collect the data. The result shows that out of 60
samples, 38 (63.33%) had inadequate knowledge, 12 (20%) of them had moderately adequate
knowledge, and 10 (16.67%) of them had adequate knowledge. There is a significant
association between the age and type of treatment at the level of p<0.05 with the level of
knowledge on hypoglycemia. The study findings emphasized that majority of the patients
with diabetes mellitus do not have the knowledge on hypoglycemia. The health-care
professional has an important role in educating diabetics on hypoglycemia so that
hypoglycemic episodes and morbidity could be reduced or prevented.

International Journal of Advances in Medicine

Das M et al. (2022) A study to assess the knowledge on hypoglycemia among the diabetic
patient in selected hospital, Siliguri. Int JAdv
Med;9(11):1108-1114http://www.ijmedicine.compISSN2349-3925| eISSN 2349-3933

Das M et al. (2022) conducted a study to assess the knowledge on hypoglycemia among the
diabetic patient in selected hospital, Siliguri. A descriptive cross-sectional study, was
carried out in the month of June 2022. A semi-structured questionnaire was used to
interview 100 study participants who were diabetes patients who had been admitted to the
medical ward and who had visited the endocrinology outpatient department. The study
finding shows that 52% of the samples had fair knowledge on hypoglycemia, while
23% of them had poor knowledge. The study's findings highlighted the fact that most
diabetes mellitus patients had a fair understanding of hypoglycemia. The health care
personnel should also take time and efforts to educate patients about the sign of
hypoglycemia. So that hypoglycemic episodes and morbidity could be reduced or prevented
at primordial level.

Muche EA, Mekonen BT; (2020) Hypoglycemia prevention practice and its associated factors
among diabetes patients at university teaching hospital in Ethiopia: Cross-sectional study.
PLOS ONE 15(8): e0238094. https://doi.org/10.1371/journal.pone.0238094

Muche EA, Mekonen BT; (2020) conducted a study on Hypoglycemia prevention practice
and its associated factors among diabetes patients at university teaching hospital in Ethiopia:
Cross-sectional study. A cross-sectional study was carried out on a total of 422 systematically
selected diabetic patients at the University of Gondar Referral and Teaching Hospital. The
study result shows that the majority of respondents had good knowledge of (77.5%) and
practice of (93.1%) hypoglycemia prevention. Only good participant knowledge about
hypoglycemia prevention was strongly associated with the practice of its prevention (AOR:
2.87 (1.2–6.8), p = 0.01). this study concluded that even though diabetic patients with good
knowledge of hypoglycemia and its prevention was strongly associated with good prevention
practice, there exists a gap in knowledge of hypoglycemia prevention. Hence, this study
recommend counseling be offered to patients regarding hypoglycemia during their visit to the
diabetic clinic.

Sreedevi K. (2020) A study to assess the effectiveness of structured Teaching Programme on

self-care management of patients with type 2 Diabetes mellitus and Evaluation of prognosis
in selected Hospitals. Asian J. Nursing Education and Research. 10(4):427-431. doi:
10.5958/2349-2996.2020.00091.9

Sreedevi K. (2020) conducted a study to assess the effectiveness of structured Teaching

Programme on self-care management of patients with type 2 Diabetes mellitus and
Evaluation of prognosis in selected Hospitals. A quasi experimental study was conducted on a
sample of 100 patients with type 2 diabetes mellitus attending diabetic clinic of Rajah
Muthiah Medical College and Hospital as experimental group and 100 patients with type 2
diabetes mellitus attending diabetic clinic of Government Hospital as control group.
Systematic sampling technique was used to select the patients for study. The study result
shows that the mean post-test knowledge score on general information about diabetes, diet,
exercise, medication, urine test for sugar and prevention of complications in the experimental
group was significantly higher than in the control group (P<0.001).There was significant
reduction in post-test BMI level in the experimental group when compared to the control
group (P<0.007).There was significant reduction in post-test HbA1c level in the experimental
group than in the control group (P<0.002).The post-test knowledge score on general
information on diabetes mellitus, medication and prevention of complications was also
influenced by education, which was significant at 0.01, 0.03 and 0.001 respectively. From
this study results and available literatures it is evident that education on self-care
management can improve the health status of diabetic patients and reduce complications.

Varghese, J., & Naidu, S. (2015). A Study to Assess the Effectiveness of Self Instruction
Module on Knowledge, Attitude, and Practice Regarding Prevention of Complications among
Diabetic Patients in Selected Hospitals in Pune. Corpus ID: 21703424

Varghese, J., & Naidu, S. (2015) conducted a Study to Assess the Effectiveness of Self
Instruction Module on Knowledge, Attitude, and Practice Regarding Prevention of
Complications among Diabetic Patients in Selected Hospitals in Pune. Sample size is 60
samples . Convenient sampling is selected as it is the easiest, fastest, most convenient,
accessible and most proximal to the researcher. Quantitative evaluative Pre-experimental
design with one group pre-test and post-test. The burden of diabetes is increasing globally,
particularly in developing countries. Self instruction module is a simplest technique easy to
understand, which is considered to be appropriate for the diabetic patients and applicable for
them to prevent .

Loan Thi Chu; et. al. (2021) "The Effectiveness of Health Education in Improving
Knowledge about Hypoglycemia and Insulin Pen Use among Outpatients with Type 2
Diabetes Mellitus at a Primary Care Hospital in Vietnam". Journal of Diabetes Research, vol.
2021, Article ID 9921376, 14 pages. https://doi.org/10.1155/2021/9921376

Loan Thi Chu; et. al. (2021) conducted a study on "The Effectiveness of Health Education in
Improving Knowledge about Hypoglycemia and Insulin Pen Use among Outpatients with
Type 2 Diabetes Mellitus at a Primary Care Hospital in Vietnam". A pretest–posttest study
was conducted among 80 patients with T2DM at District 11 Hospital in Ho Chi Minh City,
Vietnam. The majority were males (65.0%) and the mean age was 59.6 (standard deviation
8.1, range 35-75) years. Very few patients had good knowledge and proper insulin pen use,
with percentages ranging from 13.8% to 60%. There was a significant improvement of
knowledge and practice after the intervention. Such improvement remained high one month
and two months after the intervention. The health education intervention is effective in
improving knowledge and practice in this population. There is a pressing need for such
intervention at primary care hospitals to optimize treatment for patients with T2DM, possibly
focusing on those who had characteristics to have the best effectiveness found in this study.

Gezie GN, et. al. (2015) Knowledge and practice on prevention of hypoglycemia among
diabetic patients in South Gondar, Northwest Ethiopia: Institution based cross-sectional study.
Integr Obesity Diabetes . 1: doi: 10.15761/IOD.1000113

Gezie GN, et. al. (2015) conducted a study on Knowledge and practice on prevention of
hypoglycemia among diabetic patients in South Gondar, Northwest Ethiopia: Institution
based cross-sectional study. Four hundred sixteen diabetic patients were involved in the
study. From the total study participants 105(25.5%) were found to have good knowledge
about hypoglycemia prevention. Eighty nine (21.4%) had good practice in hypoglycemia
prevention. Educational status and being a member of diabetic association were found to be
positively associated with knowledge and practice. Knowledge and practice on hypoglycemia
prevention are poor. Members of Ethiopian Diabetic Association are very low in this study.
Thus the association should design and provide information tailored to patient education
level.
Kaur Sumanpreet, Kaur Harmanpreet. (2017) A Descriptive Study to Assess the Knowledge
Regarding Diabetes Mellitus among the Residents of Selected Rural Community, Gurdaspur,
Punjab. Int. J. Nur. Edu. and Research. 5(1): 19-26. doi: 10.5958/2454-2660.2017.00005.9

Kaur Sumanpreet, Kaur Harmanpreet. (2017) A Descriptive Study to Assess the Knowledge
Regarding Diabetes Mellitus among the Residents of Selected Rural Community, Gurdaspur,
Punjab. A Non-Experimental, Quantitative Research Approach And Univariant Descriptive
Research design was used in present study to assess the knowledge regarding diabetes
mellitus among selected rural community residents. A self structured checklist was used to
assess the knowledge regarding diabetes mellitus and convenience sampling was used. The
result of present study revealed that out of 100 community people, 90% have average
knowledge, 9% have good knowledge and only 1% have poor knowledge. The mean score of
good level of knowledge was 21.77 with standard deviation ±0.56, the mean score of average
knowledge was 16.97 with standard deviation ±0.35 and mean score of poor level of
knowledge was 10 with standard deviation 0. The association between the level of knowledge
regarding Diabetes Mellitus of residents of selected rural community with their demographic
variables. The analysis of the data regarding the assessment level of the knowledge regarding
diabetes mellitus among the residents of community. The result of present study revealed that
out of 100 community people, 90% have average knowledge, 9% have good knowledge and
only 1% have poor knowledge.

Madani, A. , et. al. (2019) Assessing Knowledge of Hypoglycemia Symptoms among Type 2
Diabetic Patients Using Insulin, Khartoum, Sudan. Pharmacology & Pharmacy, 10, 21-30.
doi: 10.4236/pp.2019.101003.

Madani, A., et. al. (2019) conducted a study on Assessing Knowledge of Hypoglycemia
Symptoms among Type 2 Diabetic Patients Using Insulin, Khartoum, Sudan. A single centre,
hospital-based, analytical, and cross-sectional study was carried out among diabetic patients
using insulin attended to Ribat University Hospital Diabetes Clinic (RUHDC), Khartoum
State, Sudan during a period of study. A majority of patients (52%) had poor knowledge of
hypoglycemia symptoms and the common symptoms known to patients were hands tremor
(67.2%), blurred vision (52.8%) and sweating (65.6%). No associations were found among
hypoglycemia symptoms knowledge, socio-demographic and diabetes duration. Only
(25.6%) had regular visiting to educating center and physicians were the major source of
diabetes knowledge (74.4%). This study proved low patients hypoglycemia symptoms
knowledge and physician were the main sources of information about diabetes at RUHDC.
Further ideas are required in collaboration and integrated approach to filling the gap of
patients’ awareness and multidisciplinary team in diabetes management.

Cecyli, C.; et. al. (2022) Assessment of the Knowledge and Self-Care Practice on
Hypoglycemia among Patients with Diabetic Mellitus Attending Medical Opd at Smch. // C.
Cecyli, K. Preethi, A. Priyadarsini // CARDIOMETRY. No. 23. - 103-110.
doi:10.18137/cardiometry.2022.23.103110

Cecyli, C.; et. al. (2022) conducted a study on Assessment of the Knowledge and Self-Care
Practice on Hypoglycemia among Patients with Diabetic Mellitus Attending Medical Opd at
Smch. A cross sectional descriptive research design was adopted with hundred samples who
met the inclusion criteria in the hospital setting. The study result shows that out of 100
samples 76(76%) had adequate knowledge and 63(63%)had good self-care practice on
hypoglycemia. Spearman's correlation showed a positive relationship between knowledge
and self-care practice of hypoglycemia (r value = 0.720, p<0.001. This study result
emphasized that the majority of the diabetic patients had adequate knowledge and good self-
care practice on hypoglycemia. Enlightening the patients further with regular self-monitoring
of blood glucose level and obtain medical guidance and support may help the patients to stay
fit.

ORIGINAL ARTICLE| VOLUME 8, ISSUE 3, P689-692, SEPTEMBER 2020Download Full

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A study on knowledge and self-care practices about Diabetes Mellitus among patients with
type 2 Diabetes Mellitus attending selected tertiary healthcare facilities in coastal Karnataka
Anjali Shrivastva

Sameer Phadnis

Karthik Rao N

Manisha Gore

Published:February 07, 2020DOI:https://doi.org/10.1016/j.cegh.2020.01.003

Abstract

Objective

To assess knowledge and self-care practices about Diabetes among patients with type 2
Diabetes Mellitus attending selected tertiary health care institutions.

Methods

Cross-sectional study was conducted to assess the knowledge and self-care practices about
Diabetes among diagnosed Type 2 Diabetes Mellitus patients attending the out-patient
facilities of Medicine Department at selected tertiary healthcare institutions of Udupi Taluk.
The data collection occurred from January to March 2017. A total of 166 participants were
included in the study and they were selected using consecutive sampling. Knowledge about
Diabetes Mellitus was assessed using structured pre-tested questionnaire. Diabetes Self-
Management Questionnaire-Revised version was used to assess self-care practices regarding
Diabetes Mellitus.

Results

Most of the participants (>65%) had knowledge about different aspects of Diabetes. The
Mean total score of self-care practices among participants without and with intensive insulin
treatment was 6.25 ± 1.25SD and 6.20 ± 1.01SD respectively. Mean subscales score related to
dietary control, glucose management and physician contact was almost the same as that of
total mean scale score except for physical activity subscale score in both the group of
patients.

Conclusion
This study emphasizes the need to strengthen the initiatives related to generating awareness
about diabetes and improving self-care practices related to it.

Background: Hypoglycemia has a significant impact on an individual's quality of life. This

study aimed to assess knowledge of adult patients with diabetes on hypoglycemia and its
management. Methods: A cross-sectional study using a newly developed self-administered
questionnaire was conducted from April to May 2017, at National Guard Primary Health Care
Centers, Jeddah, Saudi Arabia. Simple descriptive statistics were used. Inferential statistics
was performed in the form of Student's t-test and one-way ANOVA. Regarding knowledge
questions, a score of (1) was given to the right answer, and summation of scores was
computed (the total score was 42). Knowledge scores were categorized into good, moderate,
and poor based on the mean score. Results: A total of 361 adult patients with diabetes were
involved (208 (57.6%) women; 153 (42.4%)). The majority (341; 94.5%) were Type 2
diabetes patients. Mean knowledge score was 32.0 (±8.2), and a score of ≥31.5 represented
good knowledge, while a score between 21 and 31.5 represented a moderate level of
knowledge, and a score below 21 represented poor knowledge. The majority (92.2%) had
poor level of knowledge. Factors associated with better knowledge were male sex, younger
age, being a student, or holding a bachelor degree, being single, receiving high monthly
income, Type 1 diabetes, and having previous hypoglycemia experience. Regarding
hypoglycemia management, 66.8% identified the right management, which was “eating 15 g
of fast-acting carbohydrate.” Conclusion: Most participants showed poor knowledge
regarding hypoglycemia. More efforts and time should be made during regular visits to
provide the necessary health education about hypoglycemia signs for all patients with
diabetes.

Keywords

Diabetes mellitus - hypoglycemia - knowledge - primary care

Introduction
Diabetes mellitus is one of the most common noncommunicable chronic diseases and is a
major public health problem worldwide.[[1]] Based on the recent statistics by the
International Diabetes Federation, the estimated number of people with diabetes worldwide in
2015 was 415 million adults aged 20–79 years old, and by 2040, this will reach 642 million.
[[2]] The number of adults who died from diabetes were 5 million in 2015.[[2]] In Saudi
Arabia which is among the top 10 countries of the world with the highest prevalence of
diabetes, the estimated number of patients with diabetes in 2015 was 3.4 million, with an
associated mortality of 23,420 among adults aged 20 years old or older.[[2]]

One of the true medical emergencies associated with Type 1 diabetes (T1D) and Type 2
diabetes (T2D) is hypoglycemia. According to the American Diabetes Association,
hypoglycemia is defined as blood glucose level fall below 3.9 mmol/L (70 mg/dL) and
classified into symptomatic and asymptomatic hypoglycemia.[[3]] Hypoglycemia occurs
about two to three times more frequently in T1D than in T2D. However, because T2D is more
prevalent than T1D, most episodes of hypoglycemia, including severe hypoglycemia, occur
in people with T2D.[[4]]

According to a systemic review that was published in 2015, episodes of hypoglycemia often
occur because of patient inability to recognize symptoms of hypoglycemia and poor
knowledge about how to respond appropriately.[[5]] Hypoglycemia has a significant impact
on an individual's quality of life and has many risks, including taking place in dangerous
situations such as driving or operating machinery in work.[[6]]

Hypoglycemia can also lead to major complications in the vital organs such as brain and
kidneys which can lead to permanent neurological and renal damage.[[7]] Some principles of
prevention of hypoglycemia had been published. These principles include education about
diabetes self-management, self-monitoring of blood glucose levels, flexible and proper
insulin and/or other drug regimens, personalized glycemic goals, and consideration of known
risk factors of hypoglycemia.[[8]],[[9]]
Recognition of factors associated with the knowledge of hypoglycemic self-management and
selection of appropriate educational programs for health-care professionals and patients with
diabetes are the major issues to improve hypoglycemic attacks self-management and to
minimize the long-term complications.[[10]],[[11]]

Data on knowledge of hypoglycemia and its management among Saudi patients attending
diabetes clinics is limited. This study aimed to assess knowledge of hypoglycemia and its
management and to determine the associated factors among adult patients with diabetes at the
primary health-care centers of the National Guard Health Affairs, Jeddah, Saudi
Arabia.Methods

This cross-sectional study was conducted from April to May 2017 among adult patients with
DM attending chronic disease clinics at the primary health-care centers of the National Guard
Health Affairs in Jeddah, Saudi Arabia. Patients included were adult aged 18 years or older
with either T1D or T2D and on oral antihyperglycemic agents or insulin treatment.

Assuming knowledge prevalence of 50%, with margin of error as (5%), and confidence level
of (95%), the required sample size was 385. Study participants were selected from the three
primary health-care centers using stratified random sampling technique with equal allocation,
130 participants from each center.

A questionnaire was developed specifically for the purpose of this study. The questionnaire
was self-administered with assistance provided to those with low educational level. The
questionnaire included demographic information, duration of diabetes, current medication,
self-monitoring practices, knowledge of the symptoms, and patients' responses to
hypoglycemic symptoms, treatment, prevention, and complications in addition to the source
of information (e.g., media, newspaper, mobile, friend, spouse, parents, school, or teacher).
The questionnaire was reviewed for face and content validity by three experts in the field of
family and community medicine. The reliability of the questionnaire was assessed using the
Cronbach's alpha coefficient which was 0.802, indicating high reliability.

Data were analyzed using Statistical Package for the Social Sciences software version 21
(IBM SPSS Statistics, Armonk, New York, 10504-1722 United States, USA). Descriptive
statistics (proportion and frequency for categorical variables, mean and standard deviation for
numeric variables) was used. Inferential statistics was performed in the form of Student's t-
test and one-way ANOVA. Statistical significance was considered at P < 0.05 and confidence
interval of (95%).

Regarding knowledge questions, a score of (1) was given to the right answer. The summation
of scores was computed (the total score was 42). Knowledge scores were categorized into
good (score above 31.5, the mean knowledge score), moderate (score from 21 to 31.5), and
poor (score below 21).

Results

Of the 361 participants, 208 (57.6%) were women, and 153 (42.4%) were men, with the mean
age of 56.8 ± 12.2. Majority (123; 34.1%) did not have formal education. A total of 117
(32.4%) were housewives, 105 (29.2%) were retired, and 55 (15.2%) were current
employees. Also, 141 (39.1%) had monthly income 5000–10,000 Saudi Arabian riyal (SAR)
followed by 127 (35.2%) had monthly income <5000 SAR. In addition, 15% of the sample
were ever-smokers. Approximately 151 (41.8%) participants had other chronic illnesses
where hypertension 113 (74.8%) was the most common. Regular exercise was reported by
52.3% of the patients, where 76.7% of them perform 150 min or less [[Table 1]].The results
revealed that the mean knowledge score percentage was 32.0 (8.2). Majority of the
participants had low knowledge scores (92.2%) [[Figure 1]].
Zoom ImageZoom ImageFigure 1: Knowledge score classifications of participants

Zoom ImageZoom ImageTable 1: Demographic data of the studied population

As shown in [[Table 2]], most patients (341; 94.5%) suffered from T2D. In terms of their
current management, around 141 (39.1%) participants received insulin, while 312 (86.4%)
received oral medications. Only 39 (10.8%) of the patients stated having DM complications,
with vision-related problems being the most common (59%). More than third of the patients
reported self-monitoring of blood glucose on daily basis (35.2%). Family history of diabetes
was identified by 67.1% of the patients. Most of the information on diabetes were delivered
by physicians (68.1%), followed by family members (33.5%) then internet websites (22.2%).

Zoom ImageZoom ImageTable 2: Diabetes mellitus-related data among the studied

participants

A total of 111 (30.8%) participants had previous experience with hypoglycemic attacks,
where the main symptoms they experienced were dizziness (36%), fatigue (36%), sweating
(27%), and shakiness (27%). Almost 50% had experience of hypoglycemia within the last
month preceding the survey. Among the 111 hypoglycemia cases, only 9 (8.2%) needed
hospital admission [[Table 3]].

Zoom ImageZoom ImageTable 3: Hypoglycemia experience among the participants

Regarding the knowledge of hypoglycemia management, the majority (66.8%) chose “eating
15 g of fast-acting carbohydrate” as their preferred management option, while 26.3% reported
lack of knowledge. In addition, 183 (50.7%) identified correctly the definition of
hypoglycemia “plasma glucose concentration falling below 70 mg/dl.” The main symptoms
of hypoglycemia as identified by the patients were fatigue 251 (69.5%), followed by
shakiness 170 (47.1%), then sweating 160 (44.3%), heart palpitations 149 (41.3%), blurred
vision 142 (39.3%), and lastly was nervousness 51 (14.1%) [[Table 4]].

Zoom ImageZoom ImageTable 4: Knowledge on treatment, diagnosis, and symptoms of

hypoglycemia
The main reasons for hypoglycemia reported by the participants were skipping meals (216;
59.8%), followed by overdose medications (135; 37.4%). Almost two-thirds 229 (63.4%)
reported lack of knowledge on how to prevent hypoglycemic attacks, whereas 111 (30.7%)
believed that eating balance meals is an optimal strategy [[Table 5]]. The most common
complications regarding hypoglycemia identified by almost half of the participants were
coma 171 (47.4%), followed by Glaucoma 156 (43.2%).

Zoom ImageZoom ImageTable 5: Knowledge on reasons, prevention, and complications of

hypoglycemia

Two thirds 266 (73.6%) answered hemoglobin A1c on the question “How doctor know if the
sugar is control?” Regarding the best diet, 208 (57.7%) reported “low fat, high fiber, and low
added sugar,” and 75 (21.1%) reported “Sugar-free diet.” More than half 208 (57.7%)
reported consuming slow carbohydrates to keep blood sugar balance. Two-third said that they
were aware of hypoglycemia [[Table 6]].

Zoom ImageZoom ImageTable 6: Information of the studied participants on identification of

hypoglycemia by physicians, diet, balance, and perception of awareness

[[Table 7]] shows a significant difference in knowledge level regarding demographic data,
where male, younger patients, those with university degree, being single, being student, those
with high monthly income, T1D patients and having previous hypoglycemia experience had a
higher level of knowledge than others.

Zoom ImageZoom ImageTable 7: Comparing level of knowledge according to demographic

data

Discussion

In the last decades, diabetes has become one of the major public health problems due to its
growing prevalence. Hypoglycemia is one of the main complications of diabetes
management. The tendency among clinicians to keep blood sugar under control to decrease
the long-term complications of diabetes may play an important role in the increasing
frequency of hypoglycemia.[[12]]

The current study aimed to assess the knowledge of adult patients with diabetes regarding
hypoglycemic self-management and the factors associated with their level of knowledge.
Around 92% of the participants showed poor knowledge of hypoglycemia. Similar result was
reported in another study in Saudi Arabia where 93.9% of the participants had poor
knowledge.[[13]] In comparison, another study that was conducted in Najran City showed
that around 56% have adequate knowledge on hypoglycemia.[[14]] The difference might be
attributed to the methodological differences as the latter study considered the adequacy of
knowledge if the patient identified correctly three symptoms associated with hypoglycemia,
in comparison to our comprehensive assessment. Another possible explanation of the poor
level of knowledge of hypoglycemia among our participants is that most of our sample did
not complete the formal education which has been suggested as a barrier to effective
physician-patient communication, and hence, education about the disease management and
complications.[[15]],[[16]]

In the current study, (68.1%) reported that physicians were the main source of information,
which is consistent with another study in India Tamil Nadu, India, who identified that
(53.3%) of the patients reported doctors as the source of information.[[17]] This fact might be
utilized to design special educational classes regarding hypoglycemia to patients with
diabetes which was proven successful in previous studies.[[12]] Furthermore, these classes
may pay special attention to social background, as unemployed patients achieved lower
knowledge scores, and to the areas of weaknesses like the proper diet where only 21.1% out
of the respondents identified that correctly.

We found also that participants' knowledge scores regarding hypoglycemia were significantly
among participants who had experienced hypoglycemic attacks before. In addition,
knowledge scores were higher among participants with younger age. This is consistent with
other studies where knowledge of hypoglycemia was shown to decrease as age increased,
which sheds the light on the importance of periodic education about hypoglycemia for the
elderly patients.[[17]],[[18]],[[19]]

In contrast to Elzubier's study which was carried out on Saudi patients, male patients were
more aware of hypoglycemia.[[13]] A possible explanation is the prevalence of male
participants among their sample (67%) compared to ours (42.4%). Other studies found no
link between sex and knowledge level of hypoglycemia.[[18]]

This study has some limitations. First, we followed the cross-sectional design. Second, we
surveyed only patients in one city, and thus the results cannot be generalized to the whole
population of Saudi Arabia.

Conclusion

The majority of participants showed poor knowledge regarding hypoglycemia, while less
than one-tenth of them had moderate or good knowledge. Health-care providers in contact
with patients with diabetes are demanded to provide the necessary health education about
hypoglycemia signs for all diabetic patients during their regular visits. Educational classes
regarding hypoglycemia might be tailored to enhance the awareness about hypoglycemic
attacks to patients with DM and their caregivers.

Authors' contributions

All authors contributed adequately to the conception and conduct of the study and to drafting
and revision of the manuscript. They all reviewed and approved the final version of the
article.
#

Compliance with ethical principles

Institutional Review Board approval was obtained from King Abdullah International Medical
Research Center. Informed consent from all participants was also obtained with strict
maintenance of confidentiality of participants' dentities.

Conflict of Interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.

References

1 Non Communicable Diseases. World Health Organization; 2019. Available from:

https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. [Last accessed
on 2020 Aug 24].

2 International Diabetes Federation. IDF Diabetes ATLAS 7[th] edition 2015; 2019. p. 9.2.

3 American Diabetes Association. 6. Glycemic targets standards of medical care in diabetes

2018. Diabetes Care 2018;41:S55-64.
4 Donnelly LA, Morris AD, Frier BM, Ellis JD, Donnan PT, Durrant R, et al. Frequency and
predictors of hypoglycaemia in type 1 and insulin-treated type 2 diabetes: A population-based
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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2021; 04(01): 35-40

DOI: 10.4103/jdep.jdep_2_20

Address for correspondence

Dr. Abdullah M. Al Zahrani

Department of Family Medicine, King Saud bin Abdulaziz University for Health Sciences,
King Abdulaziz Medical City

Jeddah 23235-8457

Saudi Arabia

Email: balhood2000@yahoo.com

Publication History

Received: 15 January 2020

Accepted: 08 April 2020

Article published online:

06 July 2022

© 2021. Gulf Association of Endocrinology and Diabetes (GAED). All rights reserved. This
is an open access article published by Thieme under the terms of the Creative Commons
Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so
long as the original work is given appropriate credit. Contents may not be used for
commercial purposes, or adapted, remixed, transformed or built upon.
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Background: Hypoglycemia has a significant impact on an individual's quality of life. This

study aimed to assess knowledge of adult patients with diabetes on hypoglycemia and its
management. Methods: A cross-sectional study using a newly developed self-administered
questionnaire was conducted from April to May 2017, at National Guard Primary Health Care
Centers, Jeddah, Saudi Arabia. Simple descriptive statistics were used. Inferential statistics
was performed in the form of Student's t-test and one-way ANOVA. Regarding knowledge
questions, a score of (1) was given to the right answer, and summation of scores was
computed (the total score was 42). Knowledge scores were categorized into good, moderate,
and poor based on the mean score. Results: A total of 361 adult patients with diabetes were
involved (208 (57.6%) women; 153 (42.4%)). The majority (341; 94.5%) were Type 2
diabetes patients. Mean knowledge score was 32.0 (±8.2), and a score of ≥31.5 represented
good knowledge, while a score between 21 and 31.5 represented a moderate level of
knowledge, and a score below 21 represented poor knowledge. The majority (92.2%) had
poor level of knowledge. Factors associated with better knowledge were male sex, younger
age, being a student, or holding a bachelor degree, being single, receiving high monthly
income, Type 1 diabetes, and having previous hypoglycemia experience. Regarding
hypoglycemia management, 66.8% identified the right management, which was “eating 15 g
of fast-acting carbohydrate.” Conclusion: Most participants showed poor knowledge
regarding hypoglycemia. More efforts and time should be made during regular visits to
provide the necessary health education about hypoglycemia signs for all patients with
diabetes.